Epod Actualizacion

Clinical Guideline
Diagnosis and Management of Stable Chronic Obstructive Pulmonary Disease: A Clinical Practice Guideline Update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society
Amir Qaseem, MD, PhD, MHA; Timothy J. Wilt, MD, MPH; Steven E. Weinberger, MD; Nicola A. Hanania, MD, MS; Gerard Criner, MD;Thys van der Molen, PhD; Darcy D. Marciniuk, MD; Tom Denberg, MD, PhD; Holger Schunemann, MD, PhD, MSc; Wisia Wedzicha, PhD; ¨ Roderick MacDonald, MS; and Paul Shekelle, MD, PhD, for the American College of Physicians, the American College of Chest Physicians, the American Thoracic Society, and the European Respiratory Society*

Description: This guideline is an official statement of the AmericanCollege of Physicians (ACP), American College of Chest Physicians (ACCP), American Thoracic Society (ATS), and European Respiratory Society (ERS). It represents an update of the 2007 ACP clinical practice guideline on diagnosis and management of stable chronic obstructive pulmonary disease (COPD) and is intended for clinicians who manage patients with COPD. This guideline addresses the value ofhistory and physical examination for predicting airflow obstruction; the value of spirometry for screening or diagnosis of COPD; and COPD management strategies, specifically evaluation of various inhaled therapies (anticholinergics, long-acting -agonists, and corticosteroids), pulmonary rehabilitation programs, and supplemental oxygen therapy. Methods: This guideline is based on a targeted literatureupdate from
March 2007 to December 2009 to evaluate the evidence and update the 2007 ACP clinical practice guideline on diagnosis and management of stable COPD.

mend treatment with inhaled bronchodilators (Grade: strong recommendation, moderate-quality evidence).

Recommendation 4: ACP, ACCP, ATS, and ERS recommend that clinicians prescribe monotherapy using either long-acting inhaledanticholinergics or long-acting inhaled -agonists for symptomatic patients with COPD and FEV1 60% predicted. (Grade: strong recommendation, moderate-quality evidence). Clinicians should base the choice of specific monotherapy on patient preference, cost, and adverse effect profile. Recommendation 5: ACP, ACCP, ATS, and ERS suggest that clinicians
may administer combination inhaled therapies(long-acting inhaled anticholinergics, long-acting inhaled -agonists, or inhaled corticosteroids) for symptomatic patients with stable COPD and FEV1 60% predicted (Grade: weak recommendation, moderate-quality evidence).

Recommendation 1: ACP, ACCP, ATS, and ERS recommend that
spirometry should be obtained to diagnose airflow obstruction in patients with respiratory symptoms (Grade: strongrecommendation, moderate-quality evidence). Spirometry should not be used to screen for airflow obstruction in individuals without respiratory symptoms (Grade: strong recommendation, moderate-quality evidence).

Recommendation 6: ACP, ACCP, ATS, and ERS recommend that clinicians should prescribe pulmonary rehabilitation for symptomatic patients with an FEV1 50% predicted (Grade: strong recommendation,moderate-quality evidence). Clinicians may consider pulmonary rehabilitation for symptomatic or exercise-limited patients with an FEV1 50% predicted. (Grade: weak recommendation, moderate-quality evidence). Recommendation 7: ACP, ACCP, ATS, and ERS recommend that clinicians should prescribe continuous oxygen therapy in patients with COPD who have severe resting hypoxemia (PaO2 55 mm Hg or SpO2 88%)(Grade: strong recommendation, moderate-quality evidence).

Recommendation 2: For stable COPD patients with respiratory symptoms and FEV1 between 60% and 80% predicted, ACP, ACCP, ATS, and ERS suggest that treatment with inhaled bronchodilators may be used (Grade: weak recommendation, low-quality evidence). Recommendation 3: For stable COPD patients with respiratory symptoms and FEV1 60% predicted,...